Loculated pleural effusion, mesothelioma
A patient with known mesothelioma presents to the Emergency Department with increasing shortness of breath. Chest x-ray shows what appears to be a pleural effusion.
The question asked is:
Is this a solid mass, is is an easily drained effusion or is it something else?
This is a longitudinal lateral approach to the chest wall.
A complex, loculated effusion with elements of solid tissue was evident.
Ultrasound is an excellent technique to determine whether what appears to be a pleural effusion on plain films is actually solid, complex or a simple effusion.
As well as determining these crucial features ultrasound can measure the depth of the chest wall, and can be used to mark the best needle approach. Choose somewhere easily accessible, that gives a reasonable large target that does not move during the respiratory cycle. Also measure the size of the target prior to inserting the needle. What appears big on the ultrasound screen may be quite small!